Nutcracker Syndrome: laparoscopic external stenting of the renal vein (″the shield technique″).

Nutcracker syndrome refers to the complex of clinical symptoms caused by the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery, leading to stenosis of the aortomesenteric portion of the LRV and dilatation of the distal portion. Hematuria, proteinuria, flank pain, varicocele and pelvic congestion may occur, occurring more frequently in young adults. Conservative management, might be the option whenever it is possible. When surgical treatment is required, classically open surgery have been performed, with major surgeries as LRV transposition or bypass techniques. The main caveats regards the fact that these are large and risky surgeries. Endovascular surgery with venous stent placement has gained some space as it is minimally invasive alternative. However, venous stents are associated with a high number of trombotic complications and in many cases requirement of life-long anticoagulants. External stenting of the LRV with this "shield technique" is a minimally invasive alternative, with good medium term results. We herein demonstrate our second experience with the technique of this surgery in a patient with 12 months of follow up and excellent results.

Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project.

PURPOSE: Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil. PATIENTS AND METHODS: A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared. RESULTS: Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 (P < .002). One-year mortality was also lower in group 2. CONCLUSION: Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.

Is ureteral stent an effective way to deliver drugs such as bacillus Calmette-Guérin to the upper urinary tract? An experimental study.

BACKGROUND: We aim to evaluate the distribution in the upper urinary tract of intravesical-delivered fluids, after inducing vesicoureteral reflux (VUR) with a double J stent. METHODS: In group 1 (n = 35) patients were maintained in a 20° Trendelenburg position and were evaluated after immediate insertion of ureteral stent, while in group 2 (n = 16) patients were evaluated after several days with ureteral stent placement. Patients in both groups were submitted to a cystogram with progressive volumes of iodine contrast and were evaluated according to VUR of contrast medium to the renal pelvis. Additionally, in group 2 visual confirmation was performed by endoscopic inspection of upper tract mucosal impregnation with methylene blue. RESULTS: In group 1, after immediate insertion of ureteral stent reflux occurred in 51.4% (n = 18/35), and after several days with ureteral stent placement reflux was observed in 87.5% (n = 14/16) of patients. Reflux was progressively more frequent according to increasing bladder volume (p < 0.001). At 60 ml bladder volume no reflux was observed, while at 120 ml, 180 ml, 240 ml, 300 ml and 360 ml bladder volume reflux was observed in 14%, 25%, 41%, 55% and 63% of patients, respectively. CONCLUSION: Retrograde delivery of fluids such as bacillus Calmette-Guérin to the upper urinary tract through double J stents can be effective; however, it is mainly effective after several days with ureteral stent and relatively large volumes might be instilled into the bladder.

Massagem na saúde laboral:influência no comportamento motore estresse ocupacional / Masaje en la salud laboral: influenciaen el comportamiento motor y el estrés ocupacional / Massage on labor health: influenceon motor behavior and occupational stress

Objetivo: verificar os benefícios da massagem laboral no estresse ocupacional e comportamento motor. Método: a amostra foi composta por 31 técnicos administrativos, subdivididos de forma aleatória em um grupo experimental e outro controle, que foram submetidos no pré e pós-teste ao exame da flexibilidade, força de preensão manual e aos questionários de estresse ocupacional. No tratamento dos dados recorreu-se à estatística inferencial, aos testes Kolmogorov Smirnov, Shapiro-Wilk, Wilcoxon, t de Student para amostras pareadas, teste t de Student para amostras independentes e Mann-Whitney, com nível de significância de 5%. Resultado: nos efeitos agudos verificou-se que o grupo experimental apresentou uma melhora significativa nos níveis de força dos membros superiores direito (p= 0.039), esquerdo (p= 0.026), flexibilidade lateral da cabeça à direita (p= 0.039), apley direito (p= 0.011) e apley esquerdo (p= 0.010). Na análise dos efeitos crônicos, não foram visualizados diferenças significativas no grupo experimental, embora o grupo controle apresentasse uma redução significativa da força de preensão direita (p= 0.001), esquerda (p= 0.017) e cadeia posterior (p= 0.035).

Objetivo: comprobar los beneficios del masaje de trabajo en el estrés laboraly el comportamiento motor (flexibilidad del cuerpo y fuerza de presión)del personal administrativo. Método: la muestra fue compuesta por31 técnicos administrativos, fraccionados en pre y pos test al examen de laflexibilidad, fuerza de la prensión manual y de los cuestionarios de estréslaboral. En el tratamiento de los datos se recurrió a la estadística inferencial,a los test Kolmogorov Smirnov, Shapiro-Wilk, Wilcoxon, t de Student paralas muestras pareadas, test t Student para las muestras independientes yMann-Whitney, con nivel de significación de 5%. Resultado: en los efectosagudos se encontró que el grupo experimental mostró una mejoría significativaen los niveles de la fuerza de los miembros superiores derecho(p= 0.039), izquierdo (p= 0.026), flexibilidad lateral de la cabeza a la derecha(p= 0.039), apley derecho (p= 0.011) y apley izquierdo (p= 0.010). Enel análisis de los efectos crónicos, no hubo diferencias significativas en elgrupo experimental, mientras que el grupo control tuvo una reducción significativaen la fuerza de prensión derecha (p= 0.001), izquierda (p= 0.017)y cadena posterior (p= 0.035).

Aim: to verify the benefits of labor massage in occupational stress and motorbehavior. Method: the sample consisted of 31 administrative staff, dividedrandomly into an experimental group and a control, who underwent preandpost-test to the examination of flexibility, to handgrip strength and tothe occupational stress questionnaire. In data processing, it appealed to theinferential statistics and to the testes: Kolmogorov Smirnov, Shapiro-Wilk,Wilcoxon, Student t test for paired samples, Student t test for independentsamples and the Mann-Whitney test, with significance level of 5%. Results:in acute effects it was found that the experimental group showed a significantimprovement in the strength levels of the right (p = 0.039) and left(p = 0.026) upper limbs; lateral flexibility of the head to the right (p = 0.039), rightapley (p = 0.011) and left apley (p = 0.010). In the analysis of chronic effects,significant differences were not displayed in the experimental group, whilethe control group had a significant reduction in right grip (p = 0.001) and left(p = 0.017) strengths and posterior chain (p = 0.035).

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital.

OBJECTIVE: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. METHODS: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. RESULTS: Of the 417 patients included in the study, 83 (19.9%) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1%) confirmed diagnoses of pulmonary TB. CONCLUSIONS: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9%) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.

Autopercepção de imagem corporal por mulheres jovens adultas e da meia-idade praticantes de caminhada / Self-perception of body image for young adult and midlife women practitioners of walk

O objetivo desse estudo foi verificar a autopercepção da imagem corporal por mulheres praticantes de caminhada jovens adultas e na meia-idade da cidade de Montes Claros - MG. O estudo é descritivo, quantitativo e de delineamento transversal cuja amostragem aleatória, estratificada e proporcionalfoi de 165 mulheres. Para a variável dependente percepção da imagem corporal foi utilizado o questionário estruturado Body Shape Questionnaire(BSQ) versão para português e como varáveis independentes a idade, escolaridade, estado civil, tipo de residência, religiosidade, doença, frequência de caminhada, prática de outra atividade física e ter filhos. Os dados foram submetidos à análise descritiva e posteriormente foram realizadas as comparações fazendo uso do teste t e ANOVA. A pesquisa conta com parecer do Comitê de Ética da Universidade Estadual de Montes Claros Processo Nº 1642 de 18/09/2009. Nas mulheres jovens adultas, os resultados da percepção da imagem corporal mostraram 64,3% sem insatisfação, 31,6% com insatisfação leve, 4,1% com insatisfação moderada e na meia idade 55,2% sem insatisfação, 37,3% insatisfação leve, 7,5% insatisfação moderada. Na comparação das variáveis independentes não foram encontradas diferenças significativas em nenhum dos grupos investigados. Entre as faixas etárias analisadas, ne as etárias analisadas, nenhuma apresentou insatisfação grave com a imagem corporal. Os fatores investigados não foram impactantes na imagem corporal das jovens adultas e meia-idade.

The objetive of this study was to verify the self-perception of body image by young adult and middle-aged women practitioners of walk from the city of "Montes Claros - MG". The study was descriptive, quantitative and cross-sectional, whose sample was randomly, stratified and proportional composed by 165 women. For the dependent variable perception of body image, was used the structured questionnaire Body Shape Questionnaire (BSQ) portuguese version, and, as independent variables, we had age, schooling, marital status, type of residence, religiousness, disease, frequency of walk, practice of another physical activity and have kids. The data were submitted to descriptive analysis and after were realized the comparisons making use of "test t" and "ANOVA". The research has opinion of the Ethics Committee of the "Universidade Estadual de Montes Claros" Case No. 1642 of 09/18/2009. In young and adult women, the results of perception of body image showed 64.3% without dissatisfaction, 31.6% with light dissatisfaction, 4.1 with moderate dissatisfaction; on middle-aged, 55.2% without dissatisfaction, 37.3% with light dissatisfaction, 7.5% with moderate dissatisfaction. In comparison of independent variables, were not encountered significant differences in no one of investigated groups. Between the analyzed age lines, no one presented severe dissatisfaction with the body image. The investigated factors were not striking on the body image of young adult and middle-aged women.

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital / Análise bacteriológica do escarro induzido para o diagnóstico de tuberculose pulmonar na prática clínica de um hospital geral terciário

OBJECTIVE: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. METHODS: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. RESULTS: Of the 417 patients included in the study, 83 (19.9 percent) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95 percent CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95 percent CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1 percent) confirmed diagnoses of pulmonary TB. CONCLUSIONS: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9 percent) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.

OBJETIVO: Verificar a sensibilidade diagnóstica da análise bacteriológica do escarro induzido (EI) para o diagnóstico de tuberculose (TB) pulmonar e identificar as variáveis clínicas associadas com o diagnóstico confirmado. Além disso, avaliar o rendimento diagnóstico da broncoscopia realizada se a pesquisa de BAAR for negativa no EI. MÉTODOS: Estudo transversal e retrospectivo de pacientes com suspeita de TB pulmonar ativa, encaminhados ao serviço para a indução de escarro. Foram revisados consecutivamente os registros laboratoriais de todos os pacientes submetidos à indução de escarro entre junho de 2003 e janeiro de 2006, assim como o prontuário eletrônico de cada caso. Também foram revisados os resultados bacteriológicos das amostras broncoscópicas coletadas dos pacientes cujos resultados de BAAR em EI foram negativos. RESULTADOS: Dos 417 pacientes estudados, 83 (19,9 por cento) tiveram resultados positivos (BAAR e/ou cultura) no EI. Na análise de regressão logística, os achados radiológicos de cavitação pulmonar (OR = 3,8; IC95 por cento: 1,9-7,6) e de infiltrado de padrão miliar (OR = 3,7; IC95 por cento: 1,6-8,6) associaram-se mais significativamente com o diagnóstico de TB pulmonar. A broncoscopia foi realizada, após resultado de BAAR negativo no EI, em 134 pacientes e acrescentou 25 (64,1 por cento) diagnósticos confirmados de TB pulmonar. CONCLUSÕES: Na prática clínica, a frequência de diagnósticos confirmados de TB pulmonar por EI (19,9 por cento) foi menor do que aquela previamente relatada em ensaios controlados. Cavitação e infiltrado miliar aumentam a probabilidade diagnóstica de TB pulmonar no EI. O uso de broncoscopia quando EI é negativo para BAAR melhora significativamente a sensibilidade para o diagnóstico de TB.

Avaliação da adesão ao protocolo de pneumonia adquirida na comunidade na emergência do HCPA / Assessment of adherence to community acquired pneumonia protocol at HCPA emergency room

Objetivo: O estudo tem como objetivo principal avaliar o grau de adesão ao protocolo para manejo de Pneumonia Adquirida na Comunidade (PAC) vigente na emergência do Hospital de Clínicas de Porto Alegre (HCPA). Visamos também, buscar características epidemiológicas, clínicas e laboratoriais que possam contribuir para um desfecho mais grave nestes pacientes. Métodos: De forma prospectiva e observacional, selecionamos pacientes com diagnóstico clínico e radiológico de pneumonia, através de busca ativa na emergência do HCPA, durante o período de agosto a novembro de 2005. O já consagrado escore PORT (Pneumonia Patient outcomes Research Team) de gravidade foi utilizado para estratificação dos pacientes, os quais foram reavaliados no quinto dia. Resultados: Foram obtidos dados de 77 pacientes, com taxa geral de adesão de 65,8 por cento. Esta caiu para apenas 8,7 por cento quando analisados pacientes com PORT 1 e 2, subindo para 91,8 por cento quando considerados os pacientes com escores PORT maiores. Conclusões: Antibioticoterapia não recomendada, exames laboratoriais e internação desnecessários foram os pontos mais discordantes das recomendações do protocolo. Os dados demonstram a necessidade de uma maior adesão ao protocolo, com vistas à redução de gastos desnecessários e melhoria na qualidade do atendimento